title: The disconnect between better quality of glucocorticoid-induced osteoporosis preventive care and better outcomes: a population-based cohort study.
abstract: OBJECTIVE
  The quality of glucocorticoid-induced osteoporosis (GIOP) care [defined by bone mineral density (BMD) testing or osteoporosis treatment] is suboptimal and has been targeted for improvement. The assumption that improvements in GIOP preventive care will lead to better outcomes has not been tested.
  
  
  METHODS
  We used linked healthcare databases to conduct a population-based study of all adults 20 years of age or older in Manitoba, Canada, who initiated longterm (> 90 days) systemic glucocorticoids (GC) between 1998 and 2008. High-quality GIOP care was defined by BMD testing or prescription osteoporosis treatment within 6 months. Outcomes were adjusted odds of major fractures within 1 year and 3 years.
  
  
  RESULTS
  We studied 15,285 subjects who had just begun to take GC; 5804 (38%) were 70 years of age or older, 9185 (58%) were women, and 4755 (30%) received 10 mg or more prednisone equivalents daily. Overall, 3898 (25%) subjects received a BMD test or osteoporosis treatment within 6 months. Within 1 year of starting GC, there had been 206 major fractures (1%) and within 3 years, 553 major fractures (4%). High-quality GIOP preventive care was not associated with a reduced risk of major fractures within 1 year (adjusted OR 1.6, 95% CI 1.2-2.1) or within 3 years (adjusted OR 1.3, 95% CI 1.1-1.6).
  
  
  CONCLUSIONS
  Three-quarters of those initiating GC received suboptimal osteoporosis care. Conventional administrative database analyses could not demonstrate that better GIOP preventive care was associated with reductions in medically attended fractures. Clinically rich databases and different analytic techniques are needed to better evaluate the effectiveness of GIOP preventive care.
authors.affiliation: From the Department of Medicine, University of Alberta, Edmonton, Alberta; the Departments of Community Health Sciences and Medicine and Radiology, University of Manitoba, Winnipeg, Manitoba; and the Department of Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Lix
authors.forename: Suzanne N
authors.initials: SN
authors.lastname: Morin
authors.forename: Marina
authors.initials: M
authors.lastname: Yogendran
authors.forename: Colleen J
authors.initials: CJ
authors.lastname: Metge
authors.forename: William D
authors.initials: WD
authors.lastname: Leslie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents; D005260:Female; D050723:Fractures, Bone / Q000139:chemically induced / Q000517:prevention & control*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced / Q000517:prevention & control*; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D011787:Quality of Health Care
chemical_list: D050071:Bone Density Conservation Agents; D005938:Glucocorticoids; D011241:Prednisone
keywords: FRACTURE; GLUCOCORTICOID-INDUCED OSTEOPOROSIS; OUTCOMES; QUALITY OF CARE